Bacteraemia during tonsillectomy: a study of the factors involved and clinical implications

Abstract

Post-tonsillectomy bacteremia is a well-recognized aetiological factor in streptococcal endocarditis, and prophylactic penicillin has been recommended to reduce its incidence in susceptible patients undergoing tonsillectomy. Recent studies have shown a change in the microflora and an increase in the number of penicillin-resistant organisms in the tonsils of patients undergoing tonsillectomy. The aim of this study was to assess the incidence of post-tonsillectomy bacteraemia, to identify the micro-organisms associated with it and to review the suitability of penicillin in prophylactic regimens. The relationship between positive blood cultures and several clinical parameters such as fever, vomiting, pharyngeal discomfort, or dysphagia was also analysed. Of the 102 patients included in the study, 41 (40.1%) had positive post-tonsillectomy blood cultures. Haemophilus influenzae were isolated from 23 (56%) of the positive cultures and Streptococcus viridans in 15 (36.5%). Twenty-five per cent of H. influenzae produced beta-lactamase and only 30% of streptococci of the viridans group were penicillin-sensitive. Positivity of the blood cultures was not related to fever, discomfort, surgical technique, type of tonsil, or any of the parameters studied. Bacteraemia seems to be related to traction of the tonsil before dissection rather than direct spread of bacteria into the opened vessels. Using a beta-lactamase stable antibiotic instead of penicillin for prophylaxis would be more appropriate.

The use of perioperative antibiotics in tonsillectomy: Does it decrease morbidity?

“…Although these studies may have been useful in providing additional background information, they would not have been specifically useful for both, the qualitative and quantitative portions of this meta-analysis. On further review of the remaining 18 articles, 7 were withdrawn due to a lack of data regarding the primary clinical outcome of interest [9][10][11][12][13][14][15], and 5 were withdrawn due to the absence of a control 856 S. Iyer et al [16][17][18][19][20]. The seven remaining studies with usable information on post-operative outcomes of interest were included in the qualitative portion of this meta-analysis [21][22][23][24][25][26][27].…”

Bacteremia following pediatric adenoidectomy

“…In the literature, there are many reports of blood cultures after tonsillectomy [7,[13][14][15], but, to our knowledge, there is little information about postadenoidectomy bacteremia. Thus, Van Eyck [8] in the 70s encountered a 40% of bacteremia after adenoidectomy (two of five adenoidectomies), but he also said that ''this bacteremia is asymptomatic and remains no longer than 1 h'' [8].…”

“…We have not taken neither preoperative blood cultures nor cultures of the core or the surface of the adenoid specimens. The reasons for this are both the negativity of the cultures before adenotonsillar procedures [2,7,8,15,[16][17][18][19], and the lack of correlation between the bacteriology of the core and/ or surface of surgical specimens and the blood culture findings [11,19]. Thus, two post-curettage cultures obtained in each patient may be adequate to demonstrate the postoperative existence of bacterias within the bloodstream.…”

Antibióticos em tonsilectomias: terapêutico ou profilático? Necessário ou abusivo?

“…10 The only reason established for the use of antibiotic drugs on a prophylactic basis for patients that will undergo tonsillectomy is to prevent endocarditis and septicemia. The relation between postoperative bacteremia and development of septicemia with consequent endocarditis in patients with heart valve disease has been established by several authors 11,12 Although heart valve disease is currently less common, surgeons are more aware about the need of prophylactic use of antibiotics in patients with implants, such as SplintzHolter valves and devices of orthopedic fixation in situ. Transient bacteremia under such circumstances could lead to the development of severe infections of this sites.…”

“…Transient bacteremia under such circumstances could lead to the development of severe infections of this sites. 11 Another favorable aspect that emphasizes the use of antibiotics in tonsillectomy, since it has the purpose to reduce the incidence of postoperative infection and subsequently all events resulting from it, is that prophylactic antibiotic therapy may reduce global costs preventing expenses related to infection and reducing hospital stay. 13 With respect to the type of antibiotic to be used, changes in microbiological profile of the tonsillar tissue over the last ten years have been affecting this choice.…”